The oral contraceptive pill, or "the pill" for short, is one of the most popular methods of contraception used in Malta. Currently, it's only available for women, although a male pill is being developed.
What happens during a woman's menstrual cycle?
A woman has two ovaries and each contains thousands of immature eggs. Every month, hormones cause a few of these eggs to start ripening, until one, or very occasionally two, gets released into the uterine tubes. This is ovulation. The egg travels down the tubes into the uterus. If it happens to meet a sperm cell, it can combine to form a fertilised egg.
Meanwhile, the wall of the uterus starts to thicken. New blood vessels start forming under the surface to provide a suitable cushion for a possible pregnancy. Hormones from the released egg itself maintain this thick lining.
If there's no fertilisation, the egg continues down its passage in the uterus and gets lost. Once there's no more hormone supply from the egg, the thick uterine wall starts breaking down and sheds blood, giving rise to the woman's monthly period.
Different hormones are at play during this cycle which happens approximately every 28 days.
What is the pill?
The pill contains one or two hormones that stop ovulation, or release of the egg, and prevents pregnancy. If taken properly, it prevents pregnancy in about 91% of women.
There are two main types of contraceptive pills.
Combined Oral Contraceptives (COCs) contain two hormones - an oestrogen and a progestogen - and include Adele, Yaz, Yasmine, Yasminelle, Mercilon, Nelya, Vreya, and Qlaria.
Progestogen Only Pills (also known as mini-pill) contain only one hormone - a progestogen. Lamya is an example of a mini-pill. Mini-pills may be less effective than combined pills at preventing pregnancy, especially if a pill is taken late.
Where can I get it?
You can buy it with a doctor's prescription at any pharmacy. You may get a "repeat" prescription. In Malta, this means it's valid for 6 months.
The pill usually costs around 8 to 12 Euros per month, depending on the brand.
How is the pill taken?
Each monthly pack usually has 21 tablets that contain hormonal therapy. Some brands have packs with 21 hormonal tablets and 7 blank (or placebo) tablets. Other brands have different proportions of hormonal and blank tablets, such as 24 hormonal tablets and 4 blanks. Blank tablets may have a different colour than the hormonal tablets.
You need to take the pill every day at the same time. This is very important especially with the mini-pill.
If you find it difficult to remember to take the pill, setting a regular alarm on your phone could help.
If you miss a pill, take it as soon as you remember, even if you have to take two pills at one go. If you've missed more than one pill, it's best to seek your doctor's advice. When you miss pills, be sure to use condoms if you have intercourse and don't wish to become pregnant.
It is considered a missed pill if you delay the timing of the dose by about 12 hours. However, some types of pills, such as the mini-pill have an even shorter time period of 3 hours. Check the patient insert with the pack or speak to your pharmacist if you're unsure what's the time allowed before the pill becomes ineffective.
Take all the tablets, one by one, until the pack finishes. If you're taking a 28-day pack, start a new pack as soon as one finishes. If your pack contains 21 tablets, you have seven pill-free days, before starting a new pack. Be sure to remember to start again after the seven days or you may become pregnant.
If you have any difficulty or you're unsure how to take your pill, ask your doctor or pharmacist for advice. They'll be more than willing to explain how to take it.
What could cause the pill to stop working?
If you have vomiting or diarrhoea, the pill may not be absorbed properly and it may stop working. You should use other contraceptives, such as a condom, during these times.
Some medications, such as certain antibiotics, could also stop the pill from working. Always tell you doctor that you are on the pill before they give you other medications.
If you use the morning after pill, the regular contraceptive pill may not work for the rest of that month.
Are there any side effects?
Yes, as with any other medication, but not all women get them. Some women may feel some nausea, bloating or headaches. These usually go away after the body adjusts to the medicine.
If you feel that you're getting side effects from the pill, check with your doctor to see if there's anything you can do about it. If nothing works, you can always choose a different contraceptive that suits you better.
Can the pill be used as a treatment?
Yes, the pill is actually used very frequently to treat many conditions. These include ovarian cysts, acne and irregular cycles.
What are the advantages of taking the pill as a contraceptive?
After your doctor prescribes it for you, it's easy to obtain from pharmacies. The pill also helps periods become regular and predictable.
Moreover, there are studies that show the pill can protect the woman against certain diseases such as ovarian cancer and benign breast lumps. This protection may last up to 15 years after the pill is stopped.
Are there any disadvantages to using the pill?
The pill doesn't protect you against sexually transmitted infections (STIs). Therefore, you should also use a condom if there is a risk of infection.
The pill is also not suitable for women who have a history of high blood pressure, conditions that increase clotting, and thromboses. Your doctor will help you decide whether the pill is suitable for you.